Analgesic effect of magnesium sulfate during total intravenous anesthesia: randomized clinical study
Efeito analgésico do sulfato de magnésio durante anestesia venosa total: estudo clínico randomizado.
Sebastião E. Silva Filho, Carlson S. Sandes, Joaquim E. Vieira, Ismar L. Cavalcanti
Abstract
Introduction and objective
: Opioids have usually been used as intraoperative analgesic components, regardless of the many adverse effects they are associated with, such as nausea, vomiting, respiratory depression, and hyperalgesia. Several approaches have been investigated to reduce doses used, and magnesium sulfate has been shown to be a valuable analgesic adjunct. The main objective of the present trial was to evaluate the effectiveness of magnesium sulfate as the chief intraoperative analgesic, and the secondary objectives were to assess propofol consumption, postoperative analgesia, and intraoperative hemodynamic stability.
Methods
In this prospective, double-blind trial, 50 patients scheduled to undergo post-bariatric abdominoplasty under general intravenous anesthesia were divided into two groups, to receive remifentanil or magnesium sulfate as intraoperative analgesic. Fentanyl 1 µg.kg-1 was the rescue analgesic.
Results
Among the patients in the group receiving Magnesium Sulfate (MSG), 64% did not need supplemental analgesia and none of the patients in the Remifentanil Group (RG) required fentanyl. MSG patients showed propofol consumption 36.6% higher (guided by the Bispectral Index – BIS). MSG patients consumed significantly less ephedrine (mean ± SD) than RG patients, respectively 1.52 ± 4.38 mg and 10 ± 10.39 mg,p < 0.001. Mean values of blood concentrations of magnesium were comparable to values previously described in the literature.
Conclusion
Magnesium sulfate is a safe and effective option for intraoperative analgesia, when avoiding or decreasing opioid use is required.
Keywords
Resumo
Justificativa e objetivo: os opioides são tradicionalmente o componente analgésico intraoperatório, apesar dos muitos efeitos adversos que apresentam, como náuseas, vômitos, depressão respiratória e hiperalgesia. Várias alternativas têm sido exploradas para reduzir as doses empregadas, e o sulfato de magnésio se mostrou um adjunto analgésico importante. O objetivo principal deste ensaio foi avaliar a efetividade do sulfato de magnésio como analgésico intraoperatório principal e os objetivos secundários foram avaliar consumo de propofol, analgesia pós-operatória e estabilidade hemodinâmica intraoperatória. Métodos: neste ensaio prospectivo e duplo-encoberto, 50 pacientes programados para serem submetidos a dermolipectomia pós-bariátrica sob anestesia geral intravenosa foram distribuídos em dois grupos, para receberem remifentanil ou sulfato de magnésio como analgésico intraoperatório. Fentanil 1 µg/kg foi o analgésico de resgate. Resultados: entre os pacientes do grupo que recebeu sulfato de magnésio, 64% não necessitaram analgesia suplementar; nenhum dos pacientes no grupo remifentanil necessitou receber fentanil. Os pacientes que receberam sulfato de magnésio consumiram 36,6% mais propofol (guiado pelo índice bispectral – BIS). Os pacientes do grupo sulfato de magnésio consumiram significativamente menos efedrina (média e DP, 1,52 mg ± 4,38 mg contra 10 mg ± 10,39 mg, no GR p < 0,001). As concentrações sanguíneas médias de magnésio (Mg) seguiram o padrão encontrado na literatura. Conclusão: sulfato de magnésio é uma opção segura e eficaz para analgesia intraoperatória quando se deseja evitar ou diminuir o uso de opioides. Palavras chave: sulfato de magnésio, analgesia, dor pós-operatória.
Palavras-chave
References
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